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Comment by samsolomon | Hacker News Reader

I've done a good bit of thinking about medical note taking.

To me it's a little odd that hospitals are the ones who keep this information. I'd think that the records should belong to patients—it's about them after all. And that the patients would provide access to doctors or hospitals.

Right now I've got a personal medical journal that has things like:

* Sickness - Date Range and Notes

* Flu Shots - Date

* Injuries - Date and Notes

* Observations - Date and Notes

* Blood tests - Date and Photos of Tests

Before my yearly checkup (or if I have to visit a clinic) I review the last entries and open them on my phone incase my doctor wants to see any of them.

It works well enough for me, but seems like there could be a ton of opportunity for improvement. I'd love to have a system where my doctor could be notified and comment on new notes or events. Also the ability to bring in my scale, run tracker and other fitness data.

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The problem with this is that a very small minority of patients are that diligent or reliable, for various reasons (dementia, forgetfulness, disinterest, mental illness, low IQ, substance abuse, not realising the information is required, brought in by ambulance unconscious and peri-arrest, etc.).

Here in the UK patients do have responsibility for some records - notably anticoagulation records and maternity / child health records.

I have seen literally one patient present with their anticoagulation record. I have lost count of the number of patients who come to appointments without their maternity notes or child health notes.

Even trying to get an accurate medication history from a patient is near impossible and we end up having to look at past hospital discharge letters, call their GP, or look on shared record systems to try and piece together what they are taking.

I'm all for patients "owning" their records but they must be held in a way that is accessible when needed regardless of human variabilities.

Notes intended for patients would have a different form than notes intended for doctors. Unfortunately medical records achieve neither. My notes are bloated with information needed to bill the maximum amount from the center of Medicare services, which ultimately hurts all parties.

The bloat obscures critical information from other doctors. Patients are unable to read a meaningful account of their care, and are charged more for worse services.

One thing I like about Japan, where I live now, is that every time I get a test done (and unfortunately I've had a lot of them recently), they send a copy of the results to me. I have everything my doctor has. He also writes personal notes for himself, but usually they are descriptions of symptoms when I complain about stuff. I could write them down too (and maybe I should), but those are his personal notes just to remind him what was going one when I visited him. I don't need access to that, as far as I'm concerned (although he shows me what he's writing and sometimes I even ask him to show me what he's written on a previous page).

> To me it's a little odd that hospitals are the ones who keep this information. I'd think that the records should belong to patients—it's about them after all. And that the patients would provide access to doctors or hospitals.

This is absolutely the future, with the ubiquitous devices and cloud-like infrastructure. But we are decades away from with with entire segments of the population not even having an email account.

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